Summary about Disease
Periodic Limb Movement Disorder (PLMD) is a sleep disorder characterized by repetitive, involuntary movements of the limbs, most often the legs, during sleep. These movements can disrupt sleep, leading to daytime fatigue and other symptoms. PLMD is distinct from Restless Legs Syndrome (RLS), although the two conditions can sometimes occur together.
Symptoms
Repetitive leg movements during sleep (usually big toe extension and ankle/knee/hip flexion)
Movements typically occur every 20-40 seconds.
Sleep disruption, leading to:
Daytime fatigue or sleepiness
Difficulty concentrating
Irritability
Unrefreshing sleep
Sometimes, the person is unaware of the movements. Bed partners are often the first to notice.
Causes
The exact cause of PLMD is often unknown. However, several factors may contribute:
Associated conditions: PLMD is sometimes associated with other conditions like:
Restless Legs Syndrome (RLS)
Narcolepsy
Sleep apnea
Peripheral neuropathy
Iron deficiency
Spinal cord injuries
Medications: Certain medications can trigger or worsen PLMD.
Age: PLMD becomes more common with increasing age.
Genetics: A genetic component may play a role in some cases.
Medicine Used
Medications used to treat PLMD often overlap with those used for RLS:
Dopamine agonists: Such as pramipexole (Mirapex), ropinirole (Requip), and rotigotine (Neupro). These medications help regulate dopamine levels in the brain.
Alpha-2 adrenergic agonists: Such as clonidine, may reduce limb movements.
Benzodiazepines: Such as clonazepam (Klonopin) and temazepam (Restoril). Used to improve sleep quality and reduce arousal from the movements, but can be addictive and have side effects.
Anticonvulsants: Such as gabapentin (Neurontin) and pregabalin (Lyrica). These can reduce the frequency of limb movements and improve sleep.
Iron supplements: If iron deficiency is present.
Is Communicable
No, Periodic Limb Movement Disorder is not communicable. It is not an infectious disease and cannot be spread from person to person.
Precautions
Lifestyle changes:
Maintain a regular sleep schedule.
Avoid caffeine and alcohol, especially before bed.
Regular exercise (but avoid vigorous exercise close to bedtime).
Maintain a healthy diet with adequate iron intake.
Manage stress through relaxation techniques.
Review medications: Discuss with your doctor if any medications you are taking could be contributing to PLMD.
Treat underlying conditions: If PLMD is related to another condition like iron deficiency or sleep apnea, treating the underlying condition may help reduce PLMD symptoms.
How long does an outbreak last?
PLMD is not an "outbreak" in the sense of an infectious disease. It's a chronic condition. Without treatment, the symptoms can persist indefinitely. The duration of individual limb movements is brief (seconds), but they occur repeatedly throughout the night.
How is it diagnosed?
Medical history and physical exam: The doctor will ask about your sleep habits, symptoms, and medical history.
Polysomnography (sleep study): This is the primary diagnostic tool. It involves monitoring brain waves (EEG), eye movements (EOG), muscle activity (EMG), heart rate, and breathing during sleep. The EMG specifically monitors leg muscle activity to identify the characteristic repetitive movements of PLMD.
Actigraphy: A wrist-worn device that measures movement over an extended period (days to weeks). It can help assess sleep patterns and identify periods of restlessness, but is not as definitive as polysomnography.
Iron level testing: To rule out iron deficiency as a contributing factor.
Timeline of Symptoms
The timeline of PLMD symptoms can vary, but generally follows this pattern:
Onset: Symptoms may start gradually and be initially subtle. They can become more noticeable over time. PLMD is more common with age.
Nighttime: The repetitive limb movements occur primarily during sleep, especially in non-REM sleep.
Daily impact: Sleep disruption leads to daytime fatigue, sleepiness, difficulty concentrating, and mood changes.
Progression: Without treatment, symptoms can persist and potentially worsen over time.
Variability: The severity of symptoms can fluctuate from night to night.
Important Considerations
Differential diagnosis: It's important to differentiate PLMD from other conditions that can cause similar symptoms, such as restless legs syndrome (RLS), which has a different diagnostic criteria and treatment approach.
Co-existing conditions: PLMD often occurs with other sleep disorders and medical conditions. Identifying and treating these co-existing conditions is crucial for effective management.
Treatment adherence: Following the prescribed treatment plan is essential for managing PLMD symptoms. This may involve medication, lifestyle changes, or a combination of both.
Side effects of medications: Be aware of the potential side effects of medications used to treat PLMD and discuss any concerns with your doctor.
Impact on bed partner: PLMD can significantly impact the sleep quality of the bed partner. Addressing the condition can improve the sleep and well-being of both individuals.